UMR 7268 ADÉS/Aix Marseille Université - EFS-CNRS, Faculté de Médecine Nord, 51, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France; Faculté d'Odontologie, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France.
UMR 7268 ADÉS/Aix Marseille Université - EFS-CNRS, Faculté de Médecine Nord, 51, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France; Aix Marseille Univ, LPS, Aix-en-Provence, France; APHM, Timone, Service d'Oncologie Médicale, Marseille, France.
Disabil Health J. 2018 Jul;11(3):412-419. doi: 10.1016/j.dhjo.2018.01.001. Epub 2018 Jan 31.
The provision of dental care for children with intellectual disability raises many ethical questions.
The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue.
Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis.
Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision.
There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.
为智障儿童提供牙科护理引发了许多伦理问题。
本定性研究旨在探讨为智障焦虑儿童提供牙科治疗的方法，以及随之而来的伦理困境。
2012 年 2 月至 5 月进行了半结构化访谈。采用临床方案作为讨论临床方法和引发伦理反思的起点。讨论了四个主题：与患者的首次接触、信息、对患者的态度以及从从业者角度看待治疗结果。使用主题内容分析法进行编码程序。
大多数从业者亲自从候诊室接来患者，向他们打招呼，给予特别关注，并立即开始咨询，或使用分散注意力的方法让患者放松。口头语言和演示说明最常被用来提供信息。焦虑和疼痛通过父母评估和标准化量表进行评估。采用安抚的态度。如果患者拒绝治疗或需要约束，就会出现伦理困境。从业者报告在做出临床决策时牺牲了伦理价值观（患者自主权、善行和不伤害）。
存在广泛的实践，但没有共识。本研究揭示了牙医的不同观点，他们中的大多数人采取了功利主义的观点。在这种情况下，有必要进行伦理反思，以避免冷漠的态度，或者更糟糕的是，滥用。进一步的研究将丰富这一反思。
